Provider Demographics
NPI:1619360922
Name:ST. MARIE, AMBER (M ED)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ST. MARIE
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15310 N MAY AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8864
Mailing Address - Country:US
Mailing Address - Phone:405-221-9590
Mailing Address - Fax:
Practice Address - Street 1:15310 N MAY AVE STE 202
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-221-9590
Practice Address - Fax:405-221-9591
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health